If you’re looking to enter the under-65 health insurance market for the first time, you may have many questions. We’ve debunked five ACA insurance sales myths!
With some clear guidance from Ritter, you can feel comfortable finding your clients the ACA coverage that best suits them.
1. The ACA Is Too Complicated to Understand
To first time agents, the ACA may be intimidating and complex; however, there are helpful resources that can simplify it. The Centers for Medicare & Medicaid Services (CMS) has compiled a series of beneficial web pages for agents and brokers who are just getting started and trying to understand the ACA. These documents outline the updates with the American Rescue Plan, new Special Enrollment Periods (SEPs), and information on marketplace registration. Many of these are broken down into easy-to-read PDFs or are simple web pages with all the information you need to quickly learn what you need to know before your next client meeting. There’s also an easy-to-navigate FAQ Section for agents and brokers that may answer many of the questions you have.
If you’re looking to take a deeper dive into the protection that the ACA granted to make health care affordable for more Americans, you can read a detailed summary of the ACA here.
How Ritter makes it easy: Our ACA 101 blog post breaks the ACA market down into understandable parts to help you in your sales journey. We also have a team of dedicated support agents ready to answer your questions and help you navigate the ACA. Contact your sales specialist.
2. My Clients Have to Register for Coverage Through the Federal Marketplace
The marketplace is the central hub for ACA/under-65 health plan sales. There are two types of Marketplace – Federal (FFM) and State-Based (SBM). The federal marketplace, HealthCare.gov or an approved EDE, such as HealthSherpa, is where individuals can go to purchase an ACA health insurance plan in an FFM state. If an individual resides in a state that does not participate in the federal exchange, they would purchase an ACA health plan through that state’s unique exchange (find your state’s exchange here). Clients who purchase an ACA plan through a state exchange may still be eligible for an ACA subsidy.
ACA plans may also be purchased directly from the carrier. Any plans purchased outside of the federal and state exchange are commonly referred to as off-exchange plans. However, ACA subsidies are not available with off-exchange plans.
How Ritter makes it easy: After registering with Ritter, you have access to a free HealthSherpa account. HealthSherpa is an approved Enhanced Direct Enrollment platform. It enables independent agents like you to enroll clients in ACA plans without the fuss of the marketplace.
3. Only Clients Who Are Very Poor Qualify for ACA Coverage
This is simply not true. Someone is eligible to try to enroll in marketplace health coverage if they live in the United States, are a U.S. citizen or national or are lawfully present, and are not incarcerated. Additionally, Deferred Action for Childhood Arrivals (DACA) recipients who meet all other eligibility requirements for marketplace coverage are able to enroll in a plan during the OEP or an SEP that begins the same day and lasts for 60 days.
You can learn more about immigration requirements here. Medicare beneficiaries are not eligible for ACA health coverage and are not eligible to purchase health or dental coverage through the marketplace. HealthCare.gov has resources to help you understand more about Medicare and the marketplace.
Often, individuals with lower incomes can receive subsidies in the form of tax credits and cost share reductions, that make marketplace plans more affordable. For subsidies, a client’s income, household size, and employment status are considered. The Internal Revenue Service (IRS) has resources you can use to find out if your clients qualify for a tax credit here.
The American Rescue Plan (ARP) expanded who qualifies for tax credits through 2022. Then, the Inflation Reduction Act (IRA) extended ACA subsidies for another three years — though the end of 2025. More Americans are eligible for ACA subsidies than ever before!
The ARP expanded who qualifies for tax credits. More Americans are eligible for ACA subsidies than ever before.
For clients who do not qualify for subsidies or tax credits, consider an off-exchange ACA plan. In order to cater to clients in all income ranges, many carriers offer on- and off-exchange plans. Agents can sell both types of plans!
4. There’s No Money in Selling Under-65 Health Plans
Years ago, carriers paused commissions on under-65 health products; now, there’s a lot of money to be made selling under-65 health plans! With ACA, commissions are typically earned per household member, per month. That means that when multiple family members enroll in a plan, you can earn commission on each individual’s enrollment. All carriers reward an agent with initial commissions, as well as renewal commissions when the client re-enrolls in an ACA plan for another consecutive year. ACA commissions are likely to add up quickly due to this structure!
With ACA, commissions are typically earned per household member, per month and can add up quickly.
Even if tax credits lower your client’s monthly premiums, you’ll still collect the full commission. Your commission is yours whether the client requires a lot of attention or simply a few check-ins!
Additionally, agents can cross-sell ancillary/complementary products with an ACA plan and build a pipeline for future Medicare enrollments. Selling multiple types of products creates the potential for a complete portfolio to reach clients of all ages!
How Ritter makes it easy: Our under-65 health team is here to help you make the most of selling ACA plans. Ritter can notify you of competitive carrier commissions and additional incentives. Our Ritter Docs carrier pages have news on the latest sales incentives that can help you reach your goals.
5. It’s Too Difficult to Get Certified to Sell ACA Plans
Marketplace certification is FREE, and the full version of the training must be completed only once! Recertification is required annually, but it is typically shorter than the initial training. Some states may require additional training or certification, but you do not have to certify to sell ACA products with each individual carrier.
How Ritter makes it easy: Ritter has assembled step-by-step instructions on how to become certified with the FFM and with each state-based exchange. You are able to locate certification instructions on Ritter’s Under 65 Health page. We’ve also taken the time to answer some frequently asked questions about ACA certification and training requirements in another post. After you’re certified, you’re ready to start selling ACA plans! Register with us to gain access and start contracting.
Even though myths surround the ACA, it doesn’t have to be confusing and stressful for agents. We’ve taken the time to debunk five common myths here, and we’re dedicated to supporting you as you start selling under-65 health plans. With these myths debunked, you’ll see that the under-65 health insurance market is not as intimidating as it seems. You should feel comfortable going into your next client meeting, and we’re looking forward to joining you for incredible new sales opportunities!
Editor’s Note: This post was originally published in May 2022. It has been updated to include more relevant information for the 2025 Open Enrollment Period.
Not affiliated with or endorsed by Medicare or any government agency.
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